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Category: Volume 06 Issue 07 July 2018
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Title: A Study of Echocardiographic Evaluation of Diastolic Function in Type 2 Diabetes Mellitus patients without Cardiovascular Risk Factors

Authors: Dr Yallappa Reddy H M, Dr Savesh Roshan

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i7.43

Abstract

Background: Diabetic cardiomyopathy is a well-known cardiovascular disorder. This study was aimed to evaluate diastolic function in patients with type 2 diabetes mellitus without cardiovascular risk factors based on echocardiographic findings.

Material: One year hospital based cross-sectional study. A total of 100 patients with type 2 diabetes mellitus for a period of one year were enrolled. All the patients underwent 2D echocardiography and were evaluated for diastolic dysfunction.

Observations: 58% patients were males and male to female ratio was 1.38:1. The common age group in this study was >60 years (43%) and the mean age was 55.67+-11.13 years. In 41% of the patients the duration of diabetes was between 1-5 years. 57% of the patients had uncontrolled diabetes with HbA1c of >8%. Diastolic dysfunction was present in 36% of the patients. Significant association of diastolic dysfunction was noted with age (p=0.012) and duration of diabetes (p=0.022) but no association was found with sex (p=0.118), body mass index (p=0.419) and glycemic control (p=0.433).

Conclusion: Diastolic dysfunction is widely prevalent in patients with type 2 diabetes mellitus even in the absence of cardiovascular risk factors. Increased age and duration are the significant risk factors for diastolic dysfunction in patients with type 2 diabetes mellitus.

Keywords: Diabetes mellitus; Diabetic cardiomyopathy; Diastolic dysfunction.

References

  1. Fauci AS, Kasper DS, Longo DL, Braunwald E, Hauser SL, Jameson JL, et al. Harrison’s principles of internal medicine. United States; McGraw Hill: 2015.
  2. Sarkar A, Dash S, Barik BK, Muttigi MS, Kedage V, Shetty JK, et al. Copper and Ceruloplasmin levels in relation to total thiols and GST in type 2 diabetes mellitus patients. Ind J ClinBiochem 2010;25:74-6.
  3. Koda-Kimble MA, Carlisle BA. Diabetes mellitus. In: Young LY, Koda-Kimble MA, Kradjan WA, Guglielmo BJ, eds. Applied therapeutics: the clinical use of drugs. 6th ed., Vancouver (WA): Applied therapeutics 1995; 48:481-5.
  4. Kalofoutis C, Piperi C, Kalofoutis A, Harris F, Phoenix D, Singh J. Type II diabetes mellitus and cardiovascular risk factors: Current therapeutic approaches. ExpClinCardiol 2007;12(1):17-28.
  5. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002;106:3143-421.
  6. Kazik A, Wilczek K, Poloński L. Management of diastolic heart failure. Cardiol J 2010;17:558-65.
  7. From AM, Scott CG, Chen HH. Changes in diastolic dysfunction in diabetes mellitus over time. Am J Cardiol 2009;103:1463–6.
  8. Executive summary: Standards of medical care in diabetes-2011. Diabetes Care 2011;34:S4-10.
  9. Dikshit NM, Wadia PZ, Shukla DK. Diastolic dysfunction in Diabetes Mellitus. Natl J Med Res 2013;3(3):249-52.
  10. Swain RP, Subudhi BB, Mahapatra AK, Bolapreddi V. Bridging Between Disease, Prevalence and Treatment of Diabetes Mellitus: A Review. Int J Pharm Tech Res 2015;7(2):212-28.
  11. Kopelman PG, Hitman GA. Naturally occurring antihyper glycemic and antidyslipedimic agents. The Lancet 1998;5:352.
  12. Shi Y, Frank B. The global implications of diabetes and cancer. The Lancet 1947;9933:383.
  13. Henry M, Kronenberg MD, Shlomo Melmed MD, Kenneth S. Polonsky MD. ‘Williams’s textbook of endocrinology. 12th ed., Philadelphia: Elsevier/ Saunders; 2011.
  14. Vos T, Flaxman AD, Nghavi M, Lozano R, Michaud C, Ezzati M, et al. A systemic analysis for the global burden of disease study, The Lancet 2010;380 (9859):2163.
  15. Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLOS Med 2006;3(11):442.
  16. Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res ClinPract 2010;87:4-14.
  17. Boudina S, Dale Abel E. Diabetic cardiomyopathy revisited. Circulation 2007;115:3213-23.
  18. Freire CM, Moura AL, Barbosa Mde M, Machado LJ, Nogueira AI, Ribeiro-Oliveira A. Left ventricle diastolic dysfunction in diabetes: an update. Arq Bras EndocrinolMetabol 2007;51(2):168-75.
  19. Kannel WB, Mc Gee DL. Diabetes and cardiovascular disease. The Framingham study. JAMA 1979;241(19):2035-8.
  20. Shindler DM, Kostis JB, Yusuf S, Quinones MA, Pitt B, Stewart D, et al. Diabetes mellitus, a predictor of morbidity and mortality in the Studies of Left Ventricular Dysfunction (SOLVD) Trials and Registry. Am J Cardiol 1996;77(11):1017-20.
  21. Piccini JP, Klein L, Gheorghiade M, Bonow RO. New insights into diastolic heart failure: role of diabetes mellitus. Am J Med 2004;116(suppl 5A):64S-75.
  22. Bertoni AG, Tsai A, Kasper EK, Brancati FL. Diabetes and idiopathic cardiomyopathy: a nationwide case-control study. Diabetes Care 2003; 26(10):2791-5.
  23. Nichols GA, Hillier TA, Erbey JR, Brown JB. Congestive heart failure in type 2 diabetes: prevalence, incidence, and risk factors. Diabetes Care 2001; 24(9):1614-9.
  24. Patil MB, Burji NA. Echocardiographic Evaluation of Diastolic Dysfunction in Asymptomatic Type 2 Diabetes Mellitus. JAPI 2012;60:23-6.
  25. Poulsen MK, Henriksen JE, Dahl J, Johansen A, Gerke O, Vach W, et al. Left Ventricular Diastolic Function in Type 2 Diabetes Mellitus: Prevalence and Association With Myocardial and Vascular Disease; Circ Cardiovasc Imaging 2010;3:24-31.
  26. Shrestha NR, Sharma SK, Karki P, Shrestha NK, Acharya P. Echocardigraphic evaluation of diastolic function in asymptomatic type 2 diabetes. J Nepal Assoc 2009;48(173):20-3.
  27. Soldatos G, Jandeleit-Dahm K, Thomson H, Formosa M, D’orsa K, Calkin AC, et al. Large artery biomechanics and diastolic dysfunctionin patients with Type 2 diabetes. Diabet Med 2011;28:54-60.
  28. Boyer JK, Thanigaraj S, Schechtman KB, Pérez JE. Prevalence of ventricular diastolic dysfunction in asymptomatic, normotensive patients with diabetes mellitus. Am J Cardiol2004;93:870-5.
  29. Exiara T, Konstantis A, Papazoglou L, Kouroupi M, Kalpaka A, Mporgi L, et al. Left ventricular diastolic dysfunction in diabetes mellitus Type 2. J Hypertens2010;28:e294.
  30. Fontes-Carvalho R, Ladeiras-Lopes R, Bettencourt P, Leite-Moreira A, Azevedo A. Diastolic dysfunction in the diabetic continuum: association with insulin resistance, metabolic syndrome and type 2 diabetes. CardiovascDiabetol 2015;14:4.
  31. Redfield MM, Jacobsen SJ, Burnett JC, Jr, Mahoney DW, Bailey KR, Rodeheffer RJ. Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic. JAMA 2003;289:194-202.
  32. Russo C, Jin Z, Homma S, Rundek T, Elkind MS, Sacco RL, et al. Effect of obesity and overweight on left ventricular diastolic function: a community-based study in an elderly cohort. J Am CollCardiol2011;57:1368-74.
  33. Canepa M, Strait JB, Abramov D, Milaneschi Y, AlGhatrif M, Moni M, et al. Contribution of central adiposity to left ventricular diastolic function (from the Baltimore Longitudinal Study of Aging) Am J Cardiol2012;109:1171-8.
  34. Canepa M, Strait JB, Milaneschi Y, Alghatrif M, Ramachandran R, Makrogiannis S, et al. The relationship between visceral adiposity and left ventricular diastolic function: Results from the Baltimore Longitudinal Study of Aging. NutrMetabCardiovasc Dis 2013;23:1263-70.
  35. Mishra TK, Rath PK, Mohanty NK, Mishra SK. Left ventricular systolic and diastolic dysfunction and their relationship with microvascular complications in normotensive, asymptomatic patients with type 2 diabetes mellitus. Indian Heart J 2008;60:548-53.
  36. Patil VC, Patil HV, Shah KB, Vasani JD, Shetty P. Diastolic dysfunction in asymptomatic type 2 diabetes mellitus with normal systolic function. J Cardiovasc Dis Res 2011;2(4):213-22.
  37. From AM, Scott CG, Chen HH. The development of heart failure in patients with diabetes mellitus and pre-clinical diastolic dysfunction. J Am CollCardiol2010;55:300-5.

Corresponding Author

Dr Savesh Roshan

Post Graduate, Department of General Medicine,

S.S. Institute of Medical Sciences & Research Centre, Davangere, Karnataka, India